RESUMO
OBJECTIVE: Adolescent mental health concerns increased during COVID-19, but it is unknown whether early increases in depression and suicide risk have been sustained. We examined changes in positive screens for depression and suicide risk in a large pediatric primary care network through May 2022. METHODS: Using an observational repeated cross-sectional design, we examined changes in depression and suicide risk during the pandemic using electronic health record data from adolescents. Segmented logistic regression was used to estimate risk differences (RD) for positive depression and suicide risk screens during the early pandemic (June 2020-May 2021) and late pandemic (June 2021-May 2022) relative to before the pandemic (March 2018-February 2020). Models adjusted for seasonality and standard errors accounted for clustering by practice. RESULTS: Among 222,668 visits for 115,627 adolescents (mean age 15.7, 50% female), the risk of positive depression and suicide risk screens increased during the early pandemic period relative to the prepandemic period (RD, 3.8%; 95% CI, 2.9, 4.8; RD, 2.8%; 95% CI, 1.7, 3.8). Risk of depression returned to baseline during the late pandemic period, while suicide risk remained slightly elevated (RD, 0.7%; 95% CI, -0.4, 1.7; RD, 1.8%; 95% CI, 0.9%, 2.7%). CONCLUSIONS: During the early months of the pandemic, there was an increase in positive depression and suicide risk screens, which later returned to prepandemic levels for depression but not suicide risk. Results suggest that pediatricians should continue to prioritize screening adolescents for depressive symptoms and suicide risk and connect them to treatment.
Assuntos
COVID-19 , Adolescente , Feminino , Humanos , Masculino , Estudos Transversais , Depressão/epidemiologia , Depressão/diagnóstico , Atenção Primária à Saúde , Fatores de RiscoRESUMO
INTRODUCTION: Despite compelling evidence regarding its safety and efficacy, human papilloma virus vaccination rates remain low nationally with high rates of missed vaccination opportunities. Provider recommendation is the most important factor in determining vaccine approval by families; yet, studies show that providers are hesitant to strongly recommend vaccination, especially at younger ages. We hypothesized that educational and quality improvement interventions targeting our clinical team would decrease rates of missed opportunities to vaccinate patients aged 11-13 years and improve vaccination rates among patients aged 9-10 years old. METHODS: This quality improvement project took place at an urban, academic pediatric primary care center in north Philadelphia, which serves as the medical home for over 22,000 patients. A multidisciplinary team performed a series of planned sequential interventions to improve human papilloma virus vaccination rates. The electronic health records of children aged 9-13 who presented to our center from September 2014 through December 2015 were queried. Statistical process control charts and established rules for detecting special cause variation were applied. RESULTS: Rates of missed opportunities to vaccinate 11- to 13-year-old patients decreased from 63% to 18% during the intervention period. Rates of immunization of 9- to 10-year-old patients increased from 56% to 84% during the intervention period. CONCLUSION: This low-cost, multifaceted, interdisciplinary quality improvement project resulted in a decrease in missed opportunities to vaccinate among children aged 11-13 years old and improved the vaccination rates of 9-10 year olds. Ongoing interventions are needed to sustain these efforts and to ensure timely vaccine series completion.